Friday, March 27, 2009

Hello, DieSuckah? Sorry, not dead yet!

I haven't received a single "EOB" (Explanation of Benefits) statement from DieSuckah Health Insurance Co. And since we set the dial at zero on January 1, I've got to spend some dough to meet the deductible and start having my medical expenses covered at 100%. Now, the easy thing would be if my surgery bill would just get processed: two hours in the OR totaled more than $14,000!

But, according to Die Suckah, nothing has been processed and/or applied toward my deductible, and I've spent over $1,000 out-of-pocket just on prescriptions! I tried several phone calls, always stymied by, "I need to look into this and get back to you," or "I'll talk to my supervisor and get back to you." And they never call back... and they never give me a direct number to call them back.

Today was Ultimatum Day... we will figure out what is going on and resolve it, OR ELSE. Or else what? I'm not sure... but we'd start with (the threat of) a phone call to my lawyer. Lucky me: I found someone who, after the usual mistakes, excuses, etc., actually found the hitch in the system, and fixed it. Or so he claims. I'm hopeful that he's telling the truth, that all my claims will be processed immediately, that I have met my deductible, and can even re-apply to get reimbursed for some of the prescriptions.

But here's the thing: (Can't leave well enough alone, can I? Can't just be thankful that it's resolved and let it go?) Why does it take months of phone calls and jumping up and down and hystrionics and threats... just to get them to do their jobs? Which I pay them to do! Why do I have to spend my precious energy doing battle with them? Why do I have to be the squeaky wheel, over and over again? How often do they get away with just ignoring claims?

Again, I wonder if they have back-room actuarials furiously calculating their best strategy for outlasting me. Oh, my. If they had any idea how, in my case, that strategy will have the exact opposite effect...

2 comments:

Margaret said...

Have you seen the Michael Moore movie "Sicko"? I think that would answer all your questions...

La Cootina said...

Several friends have mentioned that. My reply? "I don't need to see it. I'm living it."

Although, of COURSE, I consider myself fortunate that I was able to get an individual policy, and keep up with the premium increases. I'm QUITE sure I'd be dead by now without it. The inequities in our system are horrifying, and life-threatening, and patently unfair.